In Sickness and in Health

She climbed up into the back of the pickup and looked down at dozens of anxious faces. They could hear the sirens screaming several blocks away, where dust still hung in the air above the shattered building.

That's where these doctors, nurses and medical workers needed to be right now. It was up to this woman, who even in her white clinician's coat looked like someone's middle-aged mom, to tell them what to do.

What am I doing here?, Dr. Tisha Dowe wondered as she asked for everyone's attention. Where's the doctor who said he was in charge?

It was April 19, 1995. Dowe, director of the Oklahoma Department of Health's Maternal and Child Health Division, had arrived at her office in downtown Oklahoma City just an hour before, expecting a normal day on the job. Now she was trying to organize some 300 volunteer doctors, nurses and EMTs who'd responded to the scene of this country's most devastating act of terrorism: the bombing of the Alfred P. Murrah Federal Building.

Her boss, friend and mentor at the department, Dr. Sara Depersio, had warned Dowe not to go to the bombing site. It was dangerous, she said, and surely somebody else's responsibility.

But Dowe had been raised by a man who'd never turned his back when someone needed help. A man who'd never met a stranger in his life. A man whose neighbors relied on him in a crisis because he'd know what to do. He was also the man who had been the impetus behind Dowe's decision to become a doctor. Without the memory of her father looking over her shoulder, she wouldn't have been there to help, to organize teams to go into that horror.

Four years later, Dowe wipes her eyes and asks for a moment to regain her composure. As the newest director of the El Paso County Department of Health, headquartered in Colorado Springs, she may have just stepped into the toughest public-health job in the state -- politically, at least. Her predecessor lasted sixteen months; his predecessor had been chased into retirement by an increasingly hostile and conservative board of health, goaded on by the Christian right.

But Dowe's grief at this moment has nothing to do with her current position. As the dean of the public-health program at the University of Oklahoma once told her, to be in public health is to be surrounded by controversy. Nor are her tears for the victims in Oklahoma City. The terror of that day will remain with her forever, but she has moved on.

The tears are for the man she will never leave behind, the man no one could save. The man who told her she was meant for something beyond motherhood and an Oklahoma farmhouse.

She was born at the tiny hospital in Mooreland, Oklahoma, and christened Lititia Gaden, but no one could pronounce her first name correctly, so she became just plain Tisha. Her family lived on a farm in Seiling, a small community surrounded by wheatfields and cattle ranches in northwest Oklahoma, and a thirty-minute drive from Mooreland.

Tisha was the middle child, sandwiched between an older brother and younger sister. When she was about six, the family moved to Lamesa, Texas, thirty miles south of Lubbock, where a farm terracer that her father had invented was manufactured. But following her sixth-grade year, the family moved back to Seiling, where her father grew wheat and raised cattle like everyone else.

Julian Gaden was a big teddy bear of a man. Tisha's earliest recollections of him involved riding on his back as he told her stories, some of them about his time as a navigator in the Army Air Corps during World War II. He never talked about the horrors of what he'd seen at Guadalcanal and Okinawa. His stories were always about the great guys he'd met or something funny that happened, like the night a Japanese soldier stumbled into his foxhole. The two men looked at each other in terror, trying to decide what to do, then scrambled out of opposite sides of the foxhole and ran like hell.

Tisha had heard some of the stories so many times that, perched on his back, she'd giggle before the punchline. He'd laugh and ask her how she knew what he was going to say. She'd answer in a soft, west Oklahoma accent, "'Cause I was right behind ya, Daddy, I was right behind ya."

He was her hero -- and a hero to many others, as well. The sort of guy who couldn't pass a wreck without stopping to help. Neighbors for miles around relied on him in an emergency. If a farmer got sick, Julian Gaden was the one who organized the effort to make sure fields were tended and animals cared for. His daughter would always remember the anxious faces at the door or voices on the telephone asking for his help after an accident -- not because of any specialized training, but because he just seemed to be the one who would know what to do.

If he had a weakness, it was his cigarettes. Like thousands of other servicemen, he'd started smoking during the war. The cigarettes came with his food rations -- donated to the cause by tobacco companies -- and helped relieve boredom and tension.

Two decades later, when he was 45, they also contributed to his first heart attack. At least according to Doc Brawley, his former roommate at the University of Oklahoma and the family physician who'd delivered the Gaden children. Tisha was stunned when she got the news at her high school. Her father had seemed so immortal.

After the heart attack, her parents moved the farmhouse -- every board, window and door -- into town, where they bought a cafe. The cafe fit Julian's gregarious nature; he enjoyed talking like some people enjoy eating. But he couldn't give up the cigarettes, not after the next heart attack or the next.

The habit was so much a part of him that when Tisha got her parents to pose for a professional photographer as a present for their 25th anniversary, the photographer suggested Julian do so with a cigarette in his hand. Many years later, she would rue the fact that the only good photo she has of her father includes the poison that killed him. But she was only twenty at the time, attending college in Tulsa to become a teacher, married to her high-school sweetheart and pregnant with her first child. She believed that her father, who was always taking care of everyone else, could take care of himself.

When they'd married, Tisha's husband, Kendall, proclaimed that no wife of his was going to work outside the home. But her father had insisted she get her college degree. Her grandmother had been a teacher, and Tisha thought that seemed like a good thing to do with her life, too.

It was Kendall who talked about becoming a doctor and took the first step by getting his degree in medical technology. He was going to go on to medical school, after which they'd settle in the country, where he could practice while also attending to his first love, raising horses.

They shared that dream and begged her parents to sell them the family farm. But Tisha's father wouldn't allow it. For one of the few times in her life, she was thoroughly angry and upset with him.

"This is what we want our lives to be," she complained.

But Julian shook his head. She needed to complete her education and see where it took her. "You have a life somewhere," he said, "but not on a farm."

Her son, Justin, was born, followed by Jeremy a couple of years later. But despite her encouragement, Kendall made no move to get into medical school. She said she was willing to make the sacrifices and support him, but there was always some reason why the time wasn't right. He was too busy. Or the kids were too young. Or they didn't have the money.

In the meantime, her father's health was getting worse. Two years after her father's first heart attack, Doc Brawley had told her that if he'd been taken to a larger hospital than the one in Mooreland when he started having trouble, the technology would have existed to perform a bypass. As it was, his heart had been damaged beyond repair.

After his sixth heart attack, her father quit smoking for six months. Brawley had told him flat out that the cigarettes were preventing oxygen from reaching the muscle of his heart, and if he didn't stop smoking, the cigarettes would kill him. As it was, the doctor told his friend he wasn't to walk, much less work at the cafe. He was to limit himself to sitting in a chair or lying down in bed. He was a fifty-year-old invalid.

The summer following that heart attack, Tisha and her husband were back in Seiling, running the cafe for her parents as they had every summer to make a little money and give her folks a break. People were used to seeing her behind the counter or waiting tables. She'd worked there as a high school student -- up at six to get breakfast for the ranchers who came in the morning and then back again as soon as school let out. A cheerleader, she had to leave the games as quickly as possible to handle the post-game crowd while still wearing her uniform. She'd enjoyed working at the cafe, watching her father circulate among the tables, greeting friends and newcomers alike as family.

All the customers knew about her father's health. That's why one of them mentioned he'd seen Julian smoking again and said he thought she'd better know.

Tisha drove to her parents' home and confronted her father. "How could you do this?" she said, breaking into tears.

Her father just shook his head. He'd tried for six months, but not a day went by that he didn't crave another cigarette. "And it just never got any easier," he said. It wasn't as if he had much of a life to preserve anymore...he couldn't walk, he couldn't go out of the house. What did another cigarette matter?

It wasn't long before he suffered another heart attack. This time, Tisha's younger sister broke the news. "They had to restart dad's heart," she said. While the doctors were successful doing that, things didn't look good, and she told Tisha she'd better come home right away.

The call couldn't have come at a worse time. Tisha's first boy had recently undergone kidney surgery, and her second was just six months old and still breast-feeding. But she caught a bus from Tulsa to Oklahoma City to Seiling.

It was night when she finally arrived at the hospital. Her father lay gray and drawn, with oxygen tubes running into his nose. Even with the added help he could hardly breathe, and yet he was dying for a cigarette. He'd talked his wife into bringing him a pack; she hadn't wanted to, but he could be very insistent. Still, he couldn't smoke as long as he was hooked up to the oxygen. He had to wait until Doc Brawley came by on his rounds, then ask if he could be taken off the monitor.

Brawley refused. "He can't have even one more cigarette," the doctor warned.

But when the family got ready to go home for the night, Julian demanded that his wife leave the cigarettes. The desperate look on his face said he wasn't going to take no for an answer.

Forty minutes after they left, the phone rang at the family home. It was the hospital: Julian Gaden was dead.

He'd removed the oxygen tubes himself, then climbed out of bed and sneaked into the bathroom to have a cigarette. A nurse had found him on the floor, a lit cigarette in his hand, the rest of the pack in his robe. This time they could not restart his heart. He was 52 years old and may as well have put a gun to his head.

As much as she had admired her father, it was only after his death that Tisha realized how much he'd touched the lives of others. Friends and strangers would call or come up to her and describe some act of kindness. One woman Tisha had never met phoned to say how years earlier, she'd arrived in Seiling on a bus with no money, no job and no roof over her head. She'd wound up in the Gadens' cafe, where she got to talking to Tisha's father about the wrong turns her life had taken.

Although she was a stranger, he'd told her to hold on: He knew some folks who had a room they were looking to let out and could maybe wait to collect rent until she was on her feet. And someone else he knew just might have a job opening. He made a couple of calls, and the room and the job were hers. "He gave me a second chance at life, and I made the most of it," the woman said. "Thought you might want to know."

The woman's sentiments were echoed over and over by others. An accident victim he'd pulled from a wreck and taken to the hospital. A farmer he'd saved from financial ruin by plowing his fields and getting them planted when he was laid up. Someone he'd shared a cup of coffee and a conversation with who'd needed the moral support.

For the next few years, the thought of her father having helped so many people and not getting help himself preyed on Tisha. Maybe there was nothing that could have been done for him; even if he'd had bypass surgery, the cigarettes would have killed him eventually. But what about other Julian Gadens and their families? Couldn't something be done to help them?

Tisha kept encouraging her husband to go to medical school. But that dream had faded for him. He had a successful career -- he was director of a hospital laboratory in Tulsa -- that allowed him to spend a lot of time with his horses. Still, she kept pestering him until one day he turned to her and said, "I think you're the one who wants to be a doctor."

She didn't know what to say. She'd recently turned thirty, and with the birth of her daughter, Juliandra, a few months earlier, was now the mother of three. She enjoyed teaching school; she liked the kids and took a lot of pride in their accomplishments. And at night she taught childbirth classes in her home.

But something was missing. When she passed a car accident on the highway, she'd think of her father's competence and wonder if she would know what to do in an emergency. When she saw a middle-aged man with a cigarette in his hand, she'd wonder why no one was stopping him.

Several months after Kendall made his remark, Tisha brought up the subject. "I've been thinking about what you said," she told him. "I think you were right. I want to be a doctor."

Tisha knew it was going to be tough. Not just the schoolwork, but the strain on the family. Kendall was going to have to support them financially and take on more responsibility for caring for the children. The boys were nine and seven, her daughter one, and they were used to having their mom around.

By carefully lining out her courses so as not to spend a single unnecessary hour pursuing her degree, Tisha had cruised through college the first time in three years. Now, by doing the same thing, she figured she could get through her pre-med classes in two years and then med school in three instead of the usual four. But that would still be followed by three years of residency in order to become board-certified in a specialty.

Tisha made it through her pre-med classes with straight As. But as she interviewed with med schools, she realized the hard part was yet to come. At 32, she was older than the typical med student; at one interview, her examiner couldn't have been more than 21 or 22. "What does your mother think of you going to medical school?" he asked.

"I don't know," she replied. "I never asked."

Tisha was accepted to the University of Oklahoma School of Medicine. On the first day, she was surprised to learn that she was not the only mother in her class, nor was she the only mother who had seen the last of her twenties. However, none of the others planned to get through school as quickly.

Tisha soon learned that her instructors weren't wasting time, either. That first day, she arrived wearing sandals for what she thought would be orientation. Instead, her group was assigned to immediately begin dissecting a cadaver. She finally left the lab after ten that night, human fat squishing between her toes and smelling like, well, a dead body. After that, she always wore shoes to school.

Even with Kendall's help, juggling motherhood with the pressures of medical school almost got to her. A day before her first big bio-chemistry test, Tisha came home to find that the babysitter hadn't been watching her sons very carefully. They'd been running around the neighborhood with two other little boys collecting "batteries." Except that the batteries were actually fuses the boys had removed from outside air-conditioning units.

The humiliation of having to go around the neighborhood asking people if their air-conditioning units were working was nothing compared to the fear that gripped her when she thought about what could have happened. The boys were fortunate not to have touched any other part of the units when they yanked the fuses; someone with larger hands would most certainly have made contact and been shocked.

All sorts of recriminations went through her mind. She was being selfish, neglecting her kids to pursue a fantasy. That night she was too distracted to study. The next day, she flunked the test.

Tisha had never failed a test in her life, and the experience terrified her. How was she ever going to get through med school and still be a mother to her children? She thought about quitting, but Kendall wouldn't hear of it...at least, not under those circumstances. She could quit if she wanted, he said, but not until she got past the current crisis. If she wanted to drop out later, that was up to her. In the meantime, they'd find a more responsible babysitter.

There'd be many more times, particularly during a tough class or before a difficult test, when she thought about giving up and going back to teaching. But each time, her husband would give her the same lecture. Quit if you want when it's easy, but not just because it's tough now. So Tisha would struggle on, getting through the tough time only to discover that the idea of quitting had dissipated like a morning fog.

Her life seemed to revolve around going to school, studying, helping with the kids at night, studying some more and then trying to find a little time for sleep. Many nights she lay on the floor of the bathroom studying with the door closed so the light wouldn't keep her husband awake. She came up with a saying that other members of her study group posted in their room: "Medical school isn't nearly as hard to get into as it is to get out of."

Some of the other women in her group would complain about what in later years would be defined as sexual harassment, but in those days it was shrugged off as to be expected for a woman in a man's field. She never had a problem herself until her third year, when she and a half dozen other medical students, all of them male, were assigned to a hospital rotation and had to follow a grouchy old doctor on his rounds every morning.

From the beginning, he let Tisha know he didn't approve of her career choice. "You're going to either be a bad mother or a bad doctor," he said. "You can't do both."

Tisha didn't dare tell him he was wrong; he could ruin her career before it even got started. Instead, she learned to endure the remarks he made nearly every morning in front of the other students. She'd permed her hair for easier upkeep; he said she was "trying to look like a teenybopper." He'd make fun of the way she talked, although his eastern Oklahoma accent was every bit a match for her western one. He constantly challenged her on medical points. And in the end, he gave her bad marks for the course, anyway. Fortunately, it counted for only a third of her total grade, and the rest of her marks were excellent.

When she'd entered medical school, the idea was that Tisha would now become the country doctor -- delivering babies, attending to farm injuries -- and her husband would raise his horses. But several things happened that would bend the course of her career.

By her last year in medical school, Tisha was leaning toward a residency in obstetrics and gynecology. She liked delivering babies and working with pregnant women. The nurses all said she had an excellent touch, some of which she attributed to her own maternal experiences and the evenings she'd spent teaching childbirth classes. But two things about the field disturbed her.

The first was the number of young teens delivering babies they were not prepared to care for. One fourteen-year-old girl turned Tisha's heart into a knot when the teen came into the delivery room clutching a teddy bear.

For these girls, childbirth was not a happy occasion. It altered their lives forever, and rarely for the better. And the babies...it was liking catching them as they came over a waterfall. Tisha wondered why no one was looking upstream to figure out why there were so many.

The second issue was related to the first: abortion. Tisha had witnessed only one, and it involved the removal of a nonviable fetus that would never have lived, but it still bothered her. Although most of what she saw was an undifferentiated mass of cells, tiny arms and legs were clearly identifiable.

That sight convinced Tisha that abortion was a horrible method of birth control. And yet the issue wasn't black-and-white. This woman had wanted that child, but other women resorted to abortion because they didn't -- and what kind of life did an unwanted child have? What if such pregnancies could be prevented in the first place?

While Tisha grappled with these issues, a more immediate problem surfaced.

Kendall was worn down by the burden of supporting the family, covering her medical-school costs and shouldering most of the child-care responsibilities. The strain had been showing for several years. At first he just seemed to be getting sick a lot and tearful over small incidents that in the past wouldn't have bothered him. But the couple blew that off as stress and counted the days until Tisha completed her schooling and began practicing.

Now, though, Kendall woke up having difficulty breathing. The crying episodes were getting worse, and his back hurt constantly. Tisha made an appointment for him with a doctor who had impressed her with his thoroughness. The night before Kendall went in to see him, they sat down and listed all the symptoms so he wouldn't forget to tell the doctor. When he returned home the next day, he announced, "I've got lupus."

Overnight, Tisha had to change her plans. Completing an OB/GYN residency would take too long; Kendall wouldn't be able to handle the strain. So she opted for general practice and soon hung out her shingle. She enjoyed the work, but she kept thinking about those teen mothers and their babies.

Then she was invited to attend a seminar in Oklahoma City, where she met Sara Depersio, director of the Maternal and Child Health Division for the Oklahoma health department. Although Depersio was fifteen years older, the two women hit it off immediately.

Depersio had created the division she directed and was looking for someone who could take over when she moved on. She asked Tisha if she would come on board as the medical director for the division. Tisha quickly agreed.

But as she began this new phase of her life, another came to an end. Tisha and Kendall decided to divorce. They'd been together since they were teenagers and had supported each other through the years. But their lives were going in different directions.

The split was amicable. They even used the same lawyer and jointly wrote a letter to their families explaining the reasons. For Tisha, there was sadness and a feeling of being somewhat adrift, but as her father had once prophesied, life was waiting for her out there somewhere. Not on a farm in Oklahoma.

The possibility of someday taking over Depersio's spot motivated Tisha to get her master's degree in public health at the University of Oklahoma. The school's dean told the graduate students that they should expect to be embroiled in controversy if they remained in the field. Being a public-health doc, he said, sometimes meant stepping on the toes of individuals in order to ensure the health and safety of the public. "But if you're not out front making ripples," he said, "you're not in public health."

In 1990, Tisha, with three children in tow, moved on to the University of Hawaii as a resident in preventive medicine. She was now convinced that the way to stop tragedies like her father's death or unwanted pregnancies was to address the cause before there was a problem.

In late 1991, with her residency complete, she took a job as director of community obstetrics and gynecology at Tufts Medical School in Massachusetts. The division had won awards for its OB/GYN program, and yet the surrounding area had one of the highest infant-mortality rates in the country.

The reason was a large, impoverished immigrant population living in the area. They didn't trust the medical personnel at Tufts, who in turn made little effort to reach out to them. HIV infection rates were high, as were drug and alcohol abuse among pregnant women.

Tisha created a program to coordinate the care of these high-risk pregnancies and to get the women into treatment for their substance abuse. In doing so, she and her colleagues had to learn to communicate with a foreign culture, which taught her to seek compromises.

Her reward was something other than money, as her fourth-grade daughter pointed out one day. "Mom, the kids say you're not a real doctor because real doctors are rich," Juliandra told her.

Surprised, Tisha assured her daughter that she was a real doctor. "I just happen to be a real doctor who helps poor women have healthy babies," she said.

Juliandra was quiet for a moment, then asked, "Mom, couldn't you be just as happy helping rich women have healthy babies?"

Sure, Tisha replied. "But I can sleep well at night because I'm happy with what I'm doing."

The next year, Tisha and her daughter returned to Oklahoma. They were homesick for the boys, now attending college back home. Tisha called Depersio and discovered that her timing was perfect: Depersio had been promoted to deputy commissioner of the Oklahoma health department, and she was looking for someone to take her place at the Maternal and Child Health Division.

Over the next three years, under Tisha's direction, the division created a birth-defects registry; opened twelve clinics for rural adolescents; began family-planning services for incarcerated women; and established a fetal-alcohol-syndrome prevention program. Some of these programs were met with opposition, but by now Tisha had learned how to build consensus by finding common ground.

Confronted by both an anti-abortion faction and a pro-choice faction when trying to deal with teen-aged mothers, for example, she got both sides to the table by pointing out that they could all agree that unwanted pregnancies were a problem. From there, the two sides were able to talk face-to-face. They didn't always agree, but they conceded that the issue was not as clear-cut as they'd supposed and that there were areas -- such as addressing child sexual abuse that often leads to teenage pregnancies -- where they could work together.

By the spring of 1995, Tisha was making progress. And then one morning a Ryder truck packed with fuel oil and fertilizer blew up in front of the Murrah building in downtown Oklahoma City.

Driving down the expressway, Tisha didn't hear or feel the bomb. She didn't know anything was wrong until she got to her office and heard the initial, stunning accounts.

Her first thought was for one of the division's maternity/child-care clinics only three blocks from the federal building. She knew it was the closest medical establishment to the blast site and worried that its sole medical employee, a nurse practitioner, would be quickly overwhelmed by casualties. She tried to call the clinic but couldn't get through.

"I'm going down there," she told Depersio. Her friend tried to persuade her not to go. There was no way of knowing what was happening; if there was one bomb, there might be more. This was someone else's responsibility, Depersio told her.

But at that moment, Tisha thought of her father. He'd never walked away from someone in need. Now people needed help, and she would respond.

As she left the building, she ran into one of her best friends, nurse practitioner Pat Scott, who asked where Tisha was going. When she told her, Scott responded, "I'm going with you."

A division attorney was headed in that direction to check on his home in a nearby neighborhood; he offered them a ride. It took thirty minutes of battling traffic jams to reach the clinic. Nearly all of the windows had been blown out and the ceiling had dropped to the floor, but miraculously, no one had been injured. In fact, the clinic's nurse practitioner had already left to help at the federal building.

Tisha and Pat donned white medical coats and took off in the direction of the bombing. The closer they got, the more people they met walking, many of them dazed and bleeding, in the opposite direction. Some were picking glass out of their skin; others were crying like lost children.

The two women at last came to what was left of the building. It looked like a gigantic sledgehammer had crushed the front half, pounding an enormous crater into the ground that was filled with rubble and people searching for survivors. Fire-department trucks had parked as close as they could get to extend their ladders to the floors that hadn't collapsed.

A man noticed Tish's white coat and ran up to identify himself as a doctor; he said he was in charge of the medical response at the scene. That was fine with her; she didn't want the responsibility. She waded into the rubble and began evaluating and treating people brought to her by rescuers.

One woman said she was sitting at her desk when the wall in front of her disappeared. Crying, she described seeing the floors collapse before her eyes, like some lunatic elevator, taking people down with them.

An older man told Tisha he was the director of the U.S. Department of Agriculture office that had been housed in the building. Somehow he'd ended up under his desk when the floor above came down. He believed that the half-dozen other people in his office, some of whom he'd worked with for many years, were dead.

Tisha was checking the man for injuries when another man appeared, identifying himself as an agent with the Bureau of Alcohol, Tobacco and Firearms. "Everyone, get out now!" he yelled. "We've got a report of another possible bomb!" He and other agents were practically throwing people out of the area, trying to move them up the street, away from the site.

A nurse who was working nearby struck her head on overhanging debris as she started to run. She fell to the ground and began convulsing. Tisha later learned that she'd died from a brain hemorrhage.

Tisha was running with the older man, a hand on his elbow to steady him, when they were intercepted by a television news crew. "Where were you?" a reporter shouted.

"I don't know," the older man replied.

"Weren't you under your desk?" Tisha asked helpfully. Yes, the man suddenly recalled, he was under his desk.

It wasn't much of an interview, but it was broadcast live in Oklahoma and across the rest of the country. And that was how Tisha's three children learned where she was. Justin and Juliandra were home watching the news, unable to reach their mother on the telephone. Jeremy was in California, his back to the television, when he heard his mother's voice. They were all relieved that she was safe and knew with pride that she was where she belonged.

The fleeing medical personnel reassembled several blocks away, where agents told them to wait for instructions on when to return to the scene. Now was the time to organize into teams, Tisha thought, so that the right people could be sent to the right places. She looked around, but the man who'd identified himself as the "doctor in charge" was nowhere to be seen.

Tisha mentioned her concern to a National Guard sergeant, who seemed to be surpervising other guard members at the same assembly point. "Listen, I don't know what happened to my captain, either," he said. "So it looks like it's you and me. You take charge of the medical people, and I'll take charge of my guys."

It was not a responsibility she wanted, but there was no one else. Tisha climbed up into the bed of a pickup parked on the street and got the crowd's attention. She soon had the doctors divided by specialties -- surgeons, internists, general practitioners -- and matched them with teams of nurses and other volunteers. She assigned others to look into getting supplies -- bandages, stretchers, blood.

When the order came for medical personnel to return to the bomb site, they were ready. Tisha set up a command post at the site. As rescue workers asked for medical teams, she'd send them in, including the surgeon who gained national recognition for crawling through unstable debris in order to amputate the leg of a young woman so that she could be extracted. Other teams evaluated and treated survivors at the scene, sending the worst off in ambulances.

The scene looked like a battlefield, only many of the casualties were women and children. It was more horrible than anything Tisha thought she'd ever experience. But at the same time, she also witnessed acts of great heroism and dedication that would stand out as beacons of human spirit on an otherwise dark day.

The rescuers paid a price for their selflessness; many had to be treated for trauma and shock. One such case would sum up the tragedy for Tisha. During a lull, she was walking around the scene when she noticed a young fireman in his yellow coat and pants, sitting as close to the building as he could get.

Watching him closely for signs of shock, she noticed that whenever someone walked near him, he hid something small beneath his coat. Otherwise, he seemed oblivious to his surroundings.

After a few minutes, Tisha went over and sat down next to him. She asked to see what he was hiding, and he pulled out a small stuffed animal. He told her he'd been one of those who had crawled through the wreckage to reach the daycare center destroyed by the blast. He'd pulled baby after baby, child after child, from the rubble. "All dead," he said, weeping.

"You did what you could," she said. "This was not your fault." She stood, helped him to his feet and then gently led him, still clutching the stuffed animal, to an ambulance.

There were many more victims of the bomb than the 168 people who died that day. The injured. The other survivors. The families of the dead. All scarred for life.

Tisha didn't realize how deeply she'd been affected until the agriculture official she'd helped that day came to her office several weeks after the bombing. His family had been watching television with a neighbor when they'd seem him with the woman in the white coat. "He's with the doctor," the neighbor, a nurse who recognized Tisha, told them, promising that he was in good hands. Now he wanted to thank her.

Tisha wasn't in when the man came by, so he left a number where she could reach him. But she couldn't bring herself to call him back. He'd lost so much...all those co-workers...and she didn't know what she could say to him. That hit her hard.

A couple of weeks later, she was heading to the office when she told a friend about her reaction to the man's visit. "You have to call him," said her friend, a nurse practitioner. "You need to find closure, too."

When the pair arrived at the office, as if on cue, the man was standing there. Tisha hugged him. "Thanks," he said, as her staff looked on, teary-eyed.

On April 19, in the midst of the crisis, Tisha worried that the system had failed, that they hadn't been prepared to deal with the disaster. But on the day of her reunion with this man, she found a new perspective. The right people -- whether they were doctors or nurses or just volunteers trained in first aid -- had responded to the scene. She'd never expected to be the person in charge during a major disaster, but like her father, she accepted that she was the person whom others were counting on. She'd done what needed to be done.

In nearly incomprehensible circumstances, a system had evolved to deal with the situation. And she was proud to have been a part of it.

A few months after the bombing, Tisha resigned from the state health department and returned to private practice. She felt she needed to return to the grassroots level of medicine, healing others as she healed some of her own psychological wounds.

At her job in Massachusetts, and even when she'd first returned to Oklahoma, she'd always set some time aside to actually see patients at the clinics. But in the year before the bombing, she'd been so busy instituting new programs that she hadn't had the chance.

In late 1995, Tisha founded the Wellness Clinic in Lawton, Oklahoma. Drawing on both her public-health background and the memory of her father, she decided the clinic would emphasize preventive medicine.

It surprised Tisha's friends that her favorite patients weren't mothers and infants (she would deliver only one baby at the clinic) or even adolescents. Her favorites were middle-aged men, those near her own age -- the age when her father first started having heart attacks.

They would come to her overweight, drinking and smoking too much. But with her help, they came to understand the risk factors threatening their health, and they were motivated to change. Many of the men were used to doing sports, and Tisha played off that: Here are the rules, and this is how you play the game if you want to live longer and healthier.

In February 1999 she married Daniel Dowe, a medical/science writer and widower, combining his four children and her three into one big family. They would soon add to it by taking in troubled teens who needed a second chance at life. In doing so, Tisha often felt her father behind her.

She stayed in private practice for three years. It was rewarding work, but she missed the public-health field. At clinics, she could help only one patient at a time. In the public-health field, she could push preventive health care on a much larger scale.

One day Dr. Tisha Dowe saw an ad in a public-health journal: Colorado's El Paso County was looking for a health-department director. She'd always liked the mountains, and she and David wanted to find a place to settle down and eventually retire.

Somebody should have warned her that there are easier places to do that than El Paso county -- especially when you're director of the El Paso County Health Department.

In December 1996, Dr. John Muth, the much-loved and well-respected director of the El Paso County Health Department, resigned after sixteen years on the job, following another two decades with the U.S. Public Health Service. When he'd started at El Paso, the health department had a budget of about $1 million and a staff of 100; when he left, the department had an $11 million budget and 225 employees serving nearly half a million people.

County health departments typically deal with a wide range of health issues, from medical care for people who can't afford it otherwise to drug- and alcohol-abuse programs, the prevention of communicable diseases and restaurant inspections. Under Muth's tenure, the department had received national recognition for many of its programs -- especially its response to the AIDS epidemic through the Sexually Transmitted Disease division headed by John Potterat. Despite a rapid increase in population beginning in the 1970s, the county had seen an even more rapid decline in all sexually transmitted diseases since 1972; by the early '90s, the rate of HIV infection had stabilized while continuing to climb in other regions.

But during his last few years on the job, Muth kept tangling with religious-right groups that were becoming a political force in Colorado Springs, particularly Colorado for Family Values and James Dobson's Focus on the Family. The El Paso County Board of Commissioners, which appointed the members of the board of health that oversaw the health department, was also becoming increasingly conservative.

Religious-right activists complained about a number of health-department programs and policies. Potterat's programs came under particular attack, since they involved distribution of condoms to prostitutes and in gay bars to counter the threat of HIV infection, as well as science-based sex-education lectures in local school districts.

Potterat wasn't allowed in the schools on the north side of town, the district in which Focus on the Family has its national headquarters. "If you believe in monogamous, heterosexual marriage, you don't pass out condoms," declared Paul Jessen, executive director of Colorado for Family Values.

Muth complained about the growing influence of CFV and other groups. He defended Potterat and kept his programs in the budget. But finally he tired of the fight and submitted his letter of resignation. The next day, he received a six-point memorandum from the board of health demanding sweeping changes within the department.

Although Muth contends he knew nothing about that memo until after he'd resigned, in his resignation letter he cited "a limited ability to speak openly on politically charged health issues" as one of the reasons for his departure.

Muth stayed on in a voluntary capacity while the board searched for his replacement. So when the board of commissioners attempted to disband the board of health and take direct control of the health department, he was still around to protest.

The commissioners claimed they wanted to disband the board because it lacked proper financial oversight and had allowed the health department to overspend its budget. In reality, the department had garnered more revenue than expected and, following tradition if not sound financial practices, had given it to some of its programs without first conferring with the board.

The department's defenders noted that such transfers were not a new practice and charged that the commissioners were using it now only as an excuse to disband the board and impose their social agenda on the department.

Shortly before the budget battle began, the Colorado Springs Gazette had published an article about a gay and lesbian teen support group that happened to meet in a health-department building. Will Perkins, a longtime Colorado Springs car dealer and chairman of the CFV, protested the use of tax dollars for such a purpose.

Kathleen Gamblin, a nurse, social worker and rare liberal voice on the health board, contended that Perkins's letter had inspired the commissioners' complaints about the department overspending its budget. But their real goal, she said, was to do away with programs like condom distribution. "You cannot be a health-care giver and allow your moral beliefs to enter into the type of health care you deliver," she said.

County commissioner Duncan Bremer countered that some department employees, as well as their liberal supporters, were trying to prevent Christian groups from having a voice in public-health policy. He denied that the commissioners wanted to abolish the health board in order to influence the department's programming.

There needed to be a separation between the department and the county commissioners so that the former could deal with epidemics such as AIDS or other issues like the transportation and storage of hazardous wastes without political pressure, Muth said. He was backed by more than 200 people who showed up at the next county commissioners' meeting.

In the face of that opposition, the commissioners backed down. But their critics -- who soon formed the watchdog group Concerned Citizens for Responsible County Government -- worried that they would just look for another way to impose their will.

In March 1997, the board voted to hire Dr. Steven Englender to replace Muth. Three other candidates had already turned down the job.

Nine months later, Concerned Citizens for Responsible County Government were up in arms again when the county commissioners broke a fifty-year tradition and replaced the only physician on the health board, Dr. Ray Stecker, with dentist and former Republican county commissioner Harvey Veith. His appointment was made over the objections of the El Paso County Medical Society.

Bremer answered his critics by saying that the health board had been unwilling to listen to Christian groups regarding public-health decisions. He had no idea of Veith's religious leanings, he added.

In June 1998, attorney Robert LaBree, a former Drug Enforcement Administration administrator, resigned from the health board, and Muth applied to fill the opening. There should be a physician on the board, he said, and he was the one most qualified given his knowledge of the department and public-health issues, as well as his national connections.

But Bremer and fellow commissioner Betty Beedy were pushing another candidate: Dr. Brian Olivier, a physician-volunteer with Focus on the Family who was on the staff of the anti-abortion Colorado Springs Pregnancy Center. Bremer acknowledged that Muth was "highly qualified" but said it was too soon after his resignation as director of the department for him to be involved in department policy-making.

Concerned Citizens saw Olivier's candidacy as another attempt to control the health department. "This is the strategy of the Christian right," said group spokesman Dr. John Burrington. "Their intent nationwide is to take over school boards and boards of public health because of issues like abortion, gay and lesbian support groups and AIDS intervention."

On June 30 the commissioners appointed Dr. Jack Dillon, director of emergency services for Penrose-St. Francis Healthcare, to the opening, a move that didn't satisfy Concerned Citizens. They were still worried about what would happen when Kathleen Gamblin came up for reappointment in December.

During her five-year term, Gamblin had often been the sole boardmember to complain about the Christian right using the county commissioners to influence health-department policies. Although she welcomed Dillon's appointment, she said she didn't think the commissioners had given up. "I think they're just biding their time," she added.

They didn't bide it long. By early September 1998, rumors were circulating that Englender was in trouble. Rumor became fact when the board asked him to resign. He refused, saying it wouldn't be in the best interests of the community, the department, his family or himself.

Letters supporting Englender flooded in from community health centers, the El Paso County Medical Society, Pikes Peak United Way, the Suicide Prevention Partnership of the Pikes Peak Region and Cedar Springs Behavioral Health System, Inc. Many of these letters noted that until recently, Englender had been without administrative staff and yet he had a long list of accomplishments, not the least of which was a budget that even members of the health board praised.

On September 22, over sixty people attended that board's meeting, at which Englender's ouster was the main agenda item. All of those who spoke did so in favor of Englender. "This is not a public forum," Richard Toth, a judge, told the board. "Obviously, your minds were made up before you began."

The board then voted four to one, with Gamblin the only dissenter, to fire Englender. Citing Englender's privacy, the boardmembers refused to reveal specific reasons for his firing, even after he waived his right to privacy. "I'm here to serve the community and the department," he protested, "but it's difficult to defend yourself when no specific charges have been leveled."

Veith insisted that Englender had been told of the board's concerns at several executive sessions. He was "not leading the board in the direction we wish to go," the dentist now said.

Concerned Citizens assumed that the firing was related to Englender's staunch support for some of the department's more controversial programs. (After he was fired, Englender was silenced by a $75,000 severance package.) That assumption was later supported by Gamblin, who said Englender had run into trouble when he had opposed the commissioners' attempts to gain control of the board. But the other boardmembers hadn't come right out and said that, she admitted.

Others would. "It was politics," says Concerned Citizens member Jim Alice Scott. "The board and the county commissioners have their own social agenda, and he was in the way."

In December, the county commissioners finally got their way, appointing Olivier to replace Gamblin, who'd asked to stay on but was rejected. The commissioners also passed over Muth again, even though two years had gone by since his resignation as director of the department.

A boardmember of Voice of Truth Ministries, Medical Missions International and Good News Ministries International, Olivier contended that he didn't have an agenda. He was only interested in promoting health care, the new boardmember told the press. Olivier said he wanted to speak on behalf of the department and find ways to get more physicians to volunteer at department clinics.

Although he worked for an anti-abortion pregnancy center, he said was "a liberal in terms of individual rights." He declined to comment on the issue of condom distribution at gay bars, other than to say it wasn't something he would personally want to do.

It was this board, along with six non-voting members of the selection committee (including Gamblin), that conducted the search for the new director of the El Paso County Health Department. Two dozen people applied for the job.

By April, the field had been narrowed to four candidates. One was Dr. Tisha Dowe.

In May the board of health voted unanimously to offer Tisha the job of county health department director, at a salary of $118,000 -- $6,000 more than Englender was paid. When she hesitated, they upped the offer to $123,000, with a 5 percent increase at the end of her first year pending a satisfactory job-performance review. In June Tisha accepted the position.

Her selection seemed to satisfy almost everyone on both sides. "So far," Bremer says, he's pleased with Dowe, adding that "it's not for me to say how she's doing," since she works for the board, not the commissioners.

In fact, Bremer says, he's been wrongly portrayed as meddling in health-department politics. His views back in March 1997 were misrepresented by the press "and those on the left," he insists; he says he refused to go along with Betty Beedy and fellow commissioner Chuck Jones when they wanted to disband the board. "I like the idea of the board being somewhat independent as a buffer against political influence," he says.

The claim that the commissioners were trying to use the board to impose a social agenda on the department "was and is nonsense," Bremer continues. "What we were concerned with was a lack of good, quality administration. The other was all trumped up by people on the left trying to raise scare tactics."

Department employees welcomed Dowe, too. Potterat, whose job and programs depend on keeping his new boss's support, said he thought it would be exciting to work for a female director.

Concerned Citizens' Scott, who attended all of the public hearings where applicants spoke, says she's also impressed with Dowe. "She seems very competent, down to earth, with a lot of interest in kids' programs. I'm optimistic, but we'll have to see what happens when she runs into the conservatives' social agenda," she adds. "We'll watch with caution."

Although Tisha Dowe had heard about the department's political controversies before she accepted the job and has learned more since she moved to Colorado Springs, she says she's not worried. She remembers her graduate-school dean, who warned that to be in public health is to be surrounded by controversies. "They may be a little larger here," she admits, "but it's not much different than what I saw in Hawaii, Massachusetts and Oklahoma."

Pointing to her work with the teen-pregnancy group in Oklahoma, Dowe says she knows how to get opposing sides to the table and work from there to find compromises that everyone can live with. Her experiences with other cultures in Hawaii and Massachusetts have taught her that it's important to listen to all sides, she adds, which should please religious groups whose members have complained about being shut out of the discussion.

Already she's talking about programs to help end unplanned pregnancies, about funding to deal with the growing health issue of hepatitis C and, of course, about stopping kids from getting hooked on cigarettes. But she neatly tap-dances around the issues that keep fueling the fires in El Paso County.

Abortion is "a horrible means of birth control," she says, uttering a statement that almost anyone can agree with. But Dowe also acknowledges that there are times when it may be medically necessary, such as when the health of a mother or fetus is in danger. Under Amendment 14, no taxpayer money can be spent providing abortions anyway, she points out. She won't say how her views might affect the department's family-planning counseling.

As for condom distribution, it's too early to know what will become of those programs, she says. "Every place is different," she adds. "No one size fits all. I need time to sit down and see if what we're doing is appropriate for this area."

This early into her tenure in what could be the toughest public-health job in Colorado, it's clear that Dowe is concerned about saying anything that could stir up trouble. (Her press officer repeatedly inquired as to "what sort of article" Westword was looking to publish when a reporter asked to interview Dowe.) But if things get tough in El Paso County, neither side should expect Dowe to go down without a fight.

Her former husband, with whom she remains friends, taught her that you don't quit just because things are tough at the moment. And besides, can a political battle be worse than standing at the edge of a bomb site where 168 people died?

Dowe, who turned fifty in July, says she'd like to retire in Colorado Springs. Evidence of that is contained in a box on the floor of her office, which she found in the basement of the department. The box contains photographs of former directors dating back to 1894. Not only does the department have a long history of service to the community, she notes, but it has a history of longevity with its directors. "Two of them alone account for 45 years," she says, "and Dr. Muth was here sixteen years.

"The only one we don't have is Dr. Englender, and we'll get that one, too, and hang them all up on the wall of my office."